Evidence-based management of chronic pelvic pain.

Reiter RC
Clinical Obstetrics and Gynecology · 1998 · doi:10.1097/00003081-199806000-00023 · PMID:9646974
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This review article defines chronic pelvic pain as discomfort lasting at least six months in the lower abdomen and pelvis that causes significant disability or psychological morbidity. The author outlines an evidence-based approach to managing this syndrome, emphasizing the importance of distinguishing it from acute pain conditions due to its complex physical and psychological impacts on quality of life. While the text establishes general diagnostic criteria for the symptom cluster, it does not delve into specific pathologies or detailed treatment protocols within the provided excerpt. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Diagnosis and management of chronic pelvic pain are greatly facilitated by a multidisciplinary approach integrating medical intervention with identification and management of socioenvironmental problems, cognitive-behavioral pain strategies, and treatment of concurrent psychological morbidity. Available evidence suggests that outcomes, including pain severity, general health and functional status, and disability are more significantly improved after this approach than after isolated medical or surgical interventions. Because of the chronic nature of many of the underlying psychological and social factors predisposing to chronic symptom formation and maintenance, care of the patient with chronic pelvic pain must be continuous and longitudinal if recurrent adverse sequelae, including disability, inappropriate healthcare utilization, and recurrent depression, are to be prevented.
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Articles Evidence-Based Management of Chronic Pelvic Pain - ROBERT C. REITER Clinical Obstetrics & Gynecology 41(2):p 422-435, June 1998. Chronic pain is a symptom that may be defined as an unpleasant experience or sensation of discomfort of greater than 3 months duration that causes sufficient physical or psychological suffering or impairment to adversely affect quality of life. The syndrome of chronic pelvic pain in women is defined more restrictively as pain of at least 6 months duration involving the lower abdomen and pelvis and the disability and psychological morbidity with which it is associated. Copyright © Lippincott-Raven Publishers

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